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The fight between doctors and insurance companies over 'downcoding'

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Re: The fight between doctors and insurance companies over 'downcoding'

#201

Post by zaptheimpaler »

tptacek wrote: post #129
spiffytech wrote: post #34

Earlier quoted context omitted.

Insurance companies hold tremendous leverage over care providers, up to and including the power to effectively put them out of business on a whim. Care providers don't like picking fights with insurance companies.

Care providers make massively, massively more money than insurance providers.

You can look up Dr. Elizabeth Potter on Youtube who publicly details what its like dealing with insurance, and all the ways insurance screws her and her patients. United Health actively threatened and retaliated against her business when she started getting publicity.

The total industry wide profit numbers aren't relevant at all if you're running a small clinic going up against an insurance provider. Heck even if a single clinic made more money than an insurance provider, it would barely matter - the insurance providers have the power to stop covering your practice and kill it, a clinic does not have any such power over insurance providers.

Re: The fight between doctors and insurance companies over 'downcoding'

#202

Post by tptacek »

zaptheimpaler wrote: post #201
tptacek wrote: post #129

Earlier quoted context omitted.

Care providers make massively, massively more money than insurance providers.

You can look up Dr. Elizabeth Potter on Youtube who publicly details what its like dealing with insurance, and all the ways insurance screws her and her patients. United Health actively threatened and retaliated against her business when she started getting publicity. The total industry wide profit numbers aren't relevant at all if you're running a small clinic going up against an insurance provider. Heck even if a s…

Or I could just look at the numbers and see that providers make more than 8x what insurers do.

Re: The fight between doctors and insurance companies over 'downcoding'

#203

Post by zaptheimpaler »

tptacek wrote: post #202
zaptheimpaler wrote: post #201

Earlier quoted context omitted.

You can look up Dr. Elizabeth Potter on Youtube who publicly details what its like dealing with insurance, and all the ways insurance screws her and her patients. United Health actively threatened and retaliated against her business when she started getting publicity. The total industry wide profit numbers aren't relevant at all if you're running a small clinic going up against an insurance provider. Heck even if a s…

Or I could just look at the numbers and see that providers make more than 8x what insurers do.

And yet this has absolutely nothing to do with the claim that "Insurance companies hold tremendous leverage over care providers, up to and including the power to effectively put them out of business on a whim.", you're not even engaging with the argument at all.

Re: The fight between doctors and insurance companies over 'downcoding'

#204

Post by malfist »

cogman10 wrote: post #190
khuey wrote: post #180

Earlier quoted context omitted.

> I don’t understand why they cant just make medical expenses tax-deductible We have that, although the deduction only starts after a certain amount which makes it useless to almost everyone.

The issue is that it only kicks in when you itemize your deductions and it has something like a $10k cap. The standard deduction is 15k for a single and 30k married. Unless you have a bunch of other things to deduct, it's often the right choice to just use the standard deduction.

Unless your a homeowner with a mortgage, then it's almost always better to itemize

Re: The fight between doctors and insurance companies over 'downcoding'

#205

Post by malfist »

jimbokun wrote: post #128
supportengineer wrote: post #68

Earlier quoted context omitted.

Here are the magic words in US Health Care: "What is the cash price?" It's usually less than you think and often worth avoiding the insurance company hassle. Then you can just get reimbursed with your FSA or HSA anyway.

"What is the cash price?" magically puts you back in the land of Classical Capitalism, where the service provider wants to keep you as a customer and knows their internal costs and you as a consumer of the service can evaluate their reputation for quality and cost vs other providers. It's adding 3rd parties like "insurance" (which only works as insurance in very limited catastrophic circumstances) and government plan…

Are you calling it the magical land because it doesn't exist?

I doubt your doctors office can commit a cash price for the lab they sent you blood too.

And try doing that at a hospital and see where it gets you

Re: The fight between doctors and insurance companies over 'downcoding'

#206

Post by malfist »

hypeatei wrote: post #74
danaris wrote: post #59

Earlier quoted context omitted.

No, I assure you, it is very common for doctors' offices not to know whether a particular procedure will be covered. This is not just because of the capriciousness of insurance adjusters, but because they have to deal with all the 273 different variations of insurance plans that people who come through their offices might have. In general , a doctor's primary goal will be to get you good care. An insurance company's…

> An insurance company's only goal nowadays is to make as much money as possible How can that be true when their profits are capped on collected premiums? Look up the Medical Loss Ratio (MLR) rule to see what I'm referring to. If you wanted to squeeze money out of people, health insurance would be the least appealing industry to do that in since you're required to spend 80-85% of premiums on medical care.

Let me tell you about this little thing called Hollywood accounting

Re: The fight between doctors and insurance companies over 'downcoding'

#207

Post by jodrellblank »

ChadNauseam wrote: post #159
atomicnumber3 wrote: post #73

Earlier quoted context omitted.

>So if you think you do require some care, just ask the medical practice whether they accept self-pay and then you can decide if it's worth paying or not. If you think it's not, it's unlikely someone else will if they have to pay on your behalf. Ok, hear me out for a minute. What if I wanted to pool with several people, so that if any of us had unexpected medical needs, it wouldn't bankrupt any of us. Knowing that mo…

> Sure wish there was a system that just did that, without trying to also generate insane profits off it. Health insurance companies in the US must pay 80% of premiums to providers. All their overhead (e.g. their accountants and actuaries and so on) comes out of the remaining 20%. What's left is their profit. People have this fantasy that all the money we spend on healthcare is secretly going to greedy insurance comp…

Their overhead (e.g. their accountants and actuaries and so on) spend a lot of time inserting paperwork and delays in between hospitals and patients, fighting hospital invoices and fighting patient claims, doing marketing, and any profit the insurance company makes is money customers "spent on healthcare" which didn't end up being spent on anyone's healthcare.

> "Health insurance companies in the US must pay 80% of premiums to providers."

How was that figure decided upon, and why isn't it higher? Why isn't it "pay overheads and salaries, and return the rest to the customers"?

Re: The fight between doctors and insurance companies over 'downcoding'

#208

Post by junar »

toast0 wrote: post #81
i80and wrote: post #70

Earlier quoted context omitted.

FSAs are insane, conceptually. "Guess how much money you're spending in a year on healthcare! But beee caaareful: if you guess too high, YOU LOSE IT" I still used mine while I still had access to one, but it was grumpy-making and was usually almost more trouble than it was worth.

I lost some money, or at least had a hard time using it, because I was quoted a price for something, set the FSA for the next year based on that, and then the billing ended up where only some of the price was eligible for FSA. Combined with the PITA level, there's no way I'm doing it again. I can't see how it's worth my time. One of these three options is very likely: a) my income level is low, so every dollar counts…

There are a few caveats with the medical expense deduction.

* It's only a deduction for income tax. FSAs let you save on FICA as well.

* It's an itemized deduction. You only benefit after your total itemized deductions exceed the standard deduction. Fewer people are itemizing nowadays because the federal standard deduction is large.

* There's a 7.5% of AGI floor: you can only count medical expenses that exceed this fraction of your income.

Re: The fight between doctors and insurance companies over 'downcoding'

#210

Post by vjvjvjvjghv »

i80and wrote: post #70
supportengineer wrote: post #68

Earlier quoted context omitted.

Here are the magic words in US Health Care: "What is the cash price?" It's usually less than you think and often worth avoiding the insurance company hassle. Then you can just get reimbursed with your FSA or HSA anyway.

FSAs are insane, conceptually. "Guess how much money you're spending in a year on healthcare! But beee caaareful: if you guess too high, YOU LOSE IT" I still used mine while I still had access to one, but it was grumpy-making and was usually almost more trouble than it was worth.

FSA makes no sense. The money should just go into an HSA and be available whenever needed. Nut just this year. It should just be abolished.
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